RCM Form

New client RCM readiness and quoting assessment

Thank you for taking the time to share information about your practice. The details below will help us better understand your revenue cycle management needs, prepare an accurate quote, and create a smooth go-live plan. Please upload any available reports where requested, and if certain information is not yet available, simply let us know in your response.

Contact information

First and last name *

Practice name *

Email *

Phone number *

Complete all four contact fields, including a valid email address.

Credentialing and identifiers

For each provider, indicate whether credentialing is complete, in progress, or not started, including relevant payers and expected completion dates.

1 provider

Enter a provider name and select a status for each row.

Group NPI status *

Select the current status of the practice's Group NPI.

Select the current Group NPI status.

Systems

Current or planned EHR, practice management system, clearinghouse, payment platform, and integrations *

Tell us which systems you use or plan to use.

Reports

Excel files only (.xlsx, .xls, .xlsm, .csv). Drag files onto a row or use Choose files.

A NextGen onboarding specialist reviews submissions within two business days.

A few items still need attention

Assessment submitted

Thanks, there. Your readiness assessment is with the RCM onboarding team. You'll get a confirmation at your email, and we'll follow up on anything marked unavailable.

This is a mockup, so nothing was actually sent.